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General NPI Number Information
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NPI Number | 1144311358
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Entity Type | Organization
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Legal Business Name | DESCEND HBO2, P.A.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 3611 SONCY SUITE 5-B
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City | AMARILLO
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State | TX
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Zip | 79159-1673
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Country | US
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Telephone | 806-467-9400
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Fax | 806-467-1933
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Provider Business Mailing Address
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Address Line | 3611 SONCY SUITE 5-B
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City | AMARILLO
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State | TX
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Zip | 79119
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Country | US
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Telephone | 806-467-9400
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Fax | 806-467-1933
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROBERT CASANOVA
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Credential | MD
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Telephone | 806-467-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | G4900
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G4900
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License Number State | TX
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